Increasing access to rogue online pharmacies - those which dispense medications without a doctor's prescription - may be an important factor behind the rapid increase in the abuse of prescription drugs. In a report that was released today online by the journal Health Affairs and will also appear in its June edition, investigators from Massachusetts General Hospital (MGH) and the University of Southern California (USC) find that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.

"We know we face a growing problem with prescription drug abuse in the United States. One need only look at statistics for college campuses, where prescription drugs are fast replacing illegal substances, to see the magnitude of the problem," says Dana Goldman, PhD, director of the Schaeffer Center for Health Policy and Economics at USC, the study's senior author. "Our findings suggest that Internet growth may partly explain the increase in prescription drug abuse, since it is well known that these drugs are easily available online." Goldman is also the Norman Topping/National Medical Enterprises Chair in Medicine and Public Policy at USC.

In their report, Goldman and lead author Anupam B. Jena, MD, PhD, of the MGH Department of Medicine, note that the recent marked rise in the abuse of prescription narcotic painkillers - drugs like Percocet and Oxycontin - corresponds with an increase in the presence of online pharmacies, many of which do not adhere to regulations requiring a physician's prescription. Drugs that are frequently abused - painkillers, stimulants, sedatives and tranquilizers - often can be purchased from rogue sites that may be located outside the U.S. The current study was designed to examine the potential link between online availability and prescription drug abuse, an association that has been suspected but not investigated in depth.

Using data available from the Federal Communications Commission, the researchers first compiled statistics on access to high-speed Internet service in each state during the years studied. Since actual rates of prescription drug abuse would be difficult if not impossible to calculate, they used information on admissions to substance abuse treatment facilities from a database maintained by the U.S. Substance Abuse and Mental Health Administration. Changes in both measures over the seven years were analyzed on a per-state basis, and treatment admissions were categorized by the particular types of abused substances involved.

The analysis indicated that each 10 percent increase in the availability of high-speed Internet service in a state was accompanied by an approximately 1 percent increase in admissions for prescription drug abuse. The increases were strongest for narcotic painkillers, followed by anti-anxiety drugs, stimulants and sedatives. During the same period admissions to treat abuse of alcohol, heroin or cocaine, substances not available online, showed minimal growth or actually decreased.

"The lack of an increase in abuse of drugs not available on the Internet suggests that an overall growth in drug-seeking behavior cannot explain the rise in prescription drug abuse," Jena says. "Further studies need to better evaluate how easily commonly abused prescription drugs can be purchased online and explore the importance to the problem of foreign Internet pharmacies, which are outside the jurisdiction of the U.S. government."

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The authors note that the U.S. Pharmacy Consumer Protection Act, which went into effect in 2009, specifically prohibits delivery of controlled substances not prescribed by a physician after an in-person examination. In November of that year, the FDA also issued warnings to more than 100 online pharmacies for violations including sale of controlled substances and unapproved drugs. The impact of those measures, Jena say, is currently unknown. The Health Affairs study was funded by the National Institute on Aging and the Agency for Health Care Research and Quality.

Massachusetts General Hospital

Celebrating the 200th anniversary of its founding in 1811, Massachusetts General Hospital (http://www.massgeneral.org/) is the original and largest teaching hospital of Harvard Medical School. MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $700 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.

Schaeffer Center for Health Policy and Economics

The Schaeffer Center at USC (http://healthpolicy.usc.edu/) is one of the leading health policy centers in the United States. Currently, the Schaeffer Center conducts research and policy analysis to support evidence-based health care reform. Studies underway focus on critical health policy issues related to health care spending and value, the impacts of public policy on pharmaceutical innovation, insurance design, the macroeconomic consequences of US health care costs and comparative effectiveness and outcomes research.

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